2nd Theoretical Lecture

Fundamental and derived positions

Objectives:

After studying this lecturer, the student will be able to:

1- Identify and explain the starting positions.

2- Describe the goals and indications for fundamental and derived
positions.
3- Identify the principles of choosing the position.
4- Discuss fundamental and derived positions.

1- Starting positions and its effects.

Human Positions and Posture:

The position in which the parts of your body hold upright against gravity
is called posture. Your posture constantly changes depending on the
activity, but no matter what you are doing, you must keep holding and
moving your body in a balanced and efficient way, that is called good
posture.

Starting Positions:

In order that a movement always be performed in the same way, and thus
have a definite and measurable effect, this can occur through using a
definite starting position that must be maintained throughout the exercise.

Starting positions are divided into fundamental and derived positions.

Fundamental positions are: Standing, Kneeling, Sitting, Lying, and
Hanging. The derived positions arise from the fundamental positions by
altering the position of one or more parts of the body.

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Aims of the starting positions:

 For active movements the aim of the starting position is generally

to give the working muscles a firm origin.
 For passive movements and massage manipulations, the aim is
complete relaxation of the joints and muscles or of the tissues
manipulated.

Effects of the Starting Positions:

 By choosing suitable starting positions we can make a movement

easier or more difficult: -

(a) By giving the working muscles a more or less firm origin.

(b) By altering the position of the centre of gravity in the part of

the body to be moved

(c) By separating the origin and insertion of the working muscles

and thus increasing or decreasing their strength

(d) By giving the therapist a shorter or longer lever.

 Also we can produce relaxation in those parts which are to be

massaged or treated by passive movements

2- Goals and indications of fundamental and derived

positions.
o To provide support essential for relaxation.
o To train correct posture and balance.
o To achieve adequate fixation when movement is to be localized to
a specific joint.

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o To modify the effect of an exercise.

o For postural drainage.

3- Principles of choosing the positions or postures

The Selection of the position depends on

1- If the position is relaxed or not.

2- Indications and contra-indications of the position.
3- The available range of motion (ROM).
4- Patient’s status.
5- Type of the exercise.

4- Fundamental positions.
There are five basic or fundamental positions (standing. sitting. lying,
kneeling, and hanging). All other positions which are used are
modifications of one or other of these five and are therefore known as
derived positions.

 Standing position:

This is the most difficult of the fundamental positions to be maintained as

the whole body must be balanced and stabilizes on correct alignment on a
small base by the coordinated work of many muscle groups. The
interaction of the muscle groups concerned is controlled by a complex
series of reflexes known as the postural reflex.

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- Description of the position( figure 1):

1- The vertex is thrust upwards, the ears are leveled and the eyes look
straight forwards.
2- The neck is perpendicular on the shoulders.
3- The shoulders are drawn down and back.
4- The arms must be held close to the sides, with slightly extended
elbow, wrist and finger joints, and the palms against the thighs.
5- The back is straight, and the spine is stretched to its maximum
length
6- Hips are extended and laterally rotated slightly.
7- Pelvis is balanced on the femoral heads at the correct angle.
8- Both knees are together and extended.
9- Feet are on the same line, the heels are together, the toes slightly
apart (so that the angle between the feet does exceed 45°)

- The working muscles for taking and maintaining this position

are : -

(a) The posterior neck muscles, because the line of gravity for the head
falls in front of the cervical spine.

(b) Back muscles, because the line of gravity for the head and trunk
combined falls in front of the spine.

(c) The posterior shoulder muscles (Trapezius, Lat. Dorsi, Rhomboids),

to hold the shoulders down and back.

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Figure 1: Standing position.

 Sitting position:
- Description of the position( figure 2):
1- This position can be taken on a chair with back support or a stool,
the body is erect, and arms by the sides, the thighs are fully
supported and together.
2- Right angles are maintained at the hips, knees and ankles.
3- The knees are apart sufficiently to allow the femur to be parallel.
4- The feet rest on the floor with the heels vertically below the knees.

- The working muscles for maintaining the position: are

principally the necks, back and posterior shoulder muscles.

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Figure 2: Sitting position.

 Lying position:
- Description of the position( figure 3):
1- This is the easiest of the fundamental position as the body can be
completely supported in the supine position with the arms by the
sides and legs straight. This is the position in which the body is
most supported, with a large base and low centre of gravity.
2- The eyes are looking upward.
3- The neck is perpendicular on the shoulders.
4- Shoulders are on the same level.
5- The elbows are extended.
6- Forearms are pronated and supported on the plinth.
7- The back is straight.
8- Hips are extended.
9- Both knees are extended.
10- Heels are outside the plinth.

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- The working muscles for maintaining the position:

There is actually no real muscle work necessary for maintaining this

position. It is steady and does not disturb the effects of movements and
massage.

Figure 3: Lying position.

 Kneeling position:
- Description of the position( figure 4):
1- In this little-used position, if this position is taken on a plinth,
the feet should lie just beyond the edge, with the dorsum
touching the plinth. The knees should be together.
2- If the position is taken on the floor, the ankle joints should
preferably be plantar flexed, but may be dorsal flexed.
3- Hips are extended and the back is straight.
4- The arms are by the sides.
5- The base consists only of the legs, the centre of gravity is high
and the line of gravity falls close to the edge of the base,
making the position unstable and difficult to maintain.

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- The working muscles for maintaining the position:

The working muscles are chiefly the same as in standing fundamental

position, but the muscles of the knee joint, especially Quadriceps
Femoris, must take a greater share in balancing the body.

Figure 4: Kneeling position.

 Hanging:
- Description of the position( figure 5):
 It is taken on a horizontal bar, trapeze, or similar apparatus, usually
placed as high as to prevent the patient's feet touching the floor.
 The hands, usually pronated (= over-grasp, if they are supinated the
grasp is under-grasp), grasp the apparatus at a distance from each
other not less than shoulders-breadth.
 The arms straight and carry of the body otherwise similar to
standing position, except that the head is carried slightly back.
 The body must not hang slack like a sack of flour, but the muscles
of the arms and shoulders, especially at the back, must work to
avoid too strong stretching of ligaments and capsules.

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- The working muscles are : -

 Flexors of fingers, to fix the body to the apparatus.
 Most of the arm muscles i.e., muscles of the arms, forearms, and
shoulder girdle.
 Most of the muscles going from the trunk to the shoulder girdle
and arm.

Figure 5: Hanging position.

5- Derived positions
The position of the arms, legs or trunk may be altered in each of the
fundamental positions to modify the effect of the positions/ or of the
exercises which are performed from them.

The purpose for which the modification is made may be:

- To increase or decrease the size of the base.
- To raise or lower the center of gravity.
- To ensure maximum local or general relaxation.
- To alter the position of the body in relation to gravity.
- To provide fixation for a particular part of the body so that
movement may be localized to that part.

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- To increase or decrease the muscle work required to maintain the

position.
- To increase or decrease the leverage.

Derived positions from standing:

A. By alteration of the arms:

1. Wing standing.
- Description of the position( figure 6):
 The hands rest on the iliac crests.
 The fingers which are extended and adducted being anterior and
thumb posterior.
 Shoulders abducted, and the forearms pronated,
 The elbows are flexed and the wrists are extended.

Figure 6: Wing standing.

2. Yard standing.
- Description of the position (figure 7):

The arms are straight out from the side of the body and elevated sideways
to a horizontal position, palms facing downwards.
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Figure 7: Yard standing position.

3. Reach standing.
- Description of the position( figure 8):

Like the above position, but the hands hold some apparatus.

Figure 8: Reach standing.

B. By alteration of the legs:

1. Toe standing.
- Description of the position( figure 9):

The body is raised onto the toes by plantar flexion of the ankle joint
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Figure 9: Toe standing.

2. Step Standing.
- Description of the position( figure 10):

Standing with one foot on a higher level than the other.

Figure 10: Step standing.

C. By alteration of the trunk.

1. Stoop standing.
- Description of the position( figure 11):

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The body is bent forwards at the hips with erect back and head which are
inclined forwards. The angle to which the trunk is inclined is usually
about a right angle.

Figure 11: stoop standing.

2. Backward-bend or Arch-standing.

- Description of the position (figure 12):

This is taken by bending backward in the joints of the spine, as much as

possible in the dorsal region.

Figure 12: Arch-standing.

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3. Side-bend, or Side-arch-standing.

- Description of the position( figure 13):

Arises if the trunk is bent directly to the side. In this position, rotation
should be carefully avoided.

Figure 13. Side bend.

Derived positions from sitting:

A. By alteration of the arms: as

1. Wing.
2. Yard.
3. Reach.
B. By alteration of the legs: as
1. Half Sitting.

Patient is sitting on the side of a seat so that only one buttock is

supported. (Figure 14).

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Figure 14: Half sitting.

2. Crock sitting:
- Description of the position:

When sitting on the floor, the knees are bent so that the feet are together
and flat on the floor. The knees may be together or apart.

3. Long sitting:
- Description of the position:

The patient sits with legs fully extended and supported for the whole
of their length; the trunk and thighs at a right angle. To maintain this
position the abdominal muscles and flexors of the hip joint must
work, generally also the extensors of the knee.

C. By alteration of the trunk: as

1. Forward Lean Sitting.
- Description of the position( figure 15):

The trunk is inclined forwards and the head is supported on pillows on a

table at the front.

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Figure 15: Forward Lean Sitting.

Derived positions from lying:

a. By alteration of the arms.

Those which are used are the same as in the standing positione g.,
wing and stretch lying.

b. By alteration of the legs& trunk: as

1. Crook lying.
- Description of the position( figure 16):

From lying the knees and hips may be bent slightly by using one pillow
under the knees or, in the extremely flexed. The soles of the feet will be
flat on the support; very little muscle work is required apart from that of
the adductors and medial rotators of the hips to prevent the knees from
falling apart.

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Figure 16: Crook lying.

2. Half lying.
- Description of the position( figure 17):
 The body is bent at the hips and the trunk is raised from lying to
any angle up to 90°by inclination of the long end of the plinth,

Figure 17: Half lying.

3. Prone lying.
- Description of the position ( figure 18):

The body is face down with arms by the side and legs straight. In order to
rest comfortably two pillows should be crossed to support the forehead or
the head allowed turning to the side of the patient's choice.

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Figure 18: Prone lying.

Derived positions from kneeling:

1. Side sitting:
- Description of the position(figure 19):

For the left side sitting the left leg remains as in cross sitting and this hip
supports the main weight of the trunk, while the right leg is abducted and
medially rotated so that the lower leg is bent and to the side.

Figure 19: Side sitting position.

2. Prone kneeling:
- Description of the position(figure 20):

Kneeling supported by all four limbs. The arms should be straight and the
hands in line below the shoulders. Right angles should be maintained at
the hip and knee and the ankles may be plantarflexed or dorsiflexed.

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Figure 20: Prone kneeling.

Derived positions from hanging:

1. Half Hanging
- Description of the position:

Hanging by one arm.

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